Usefulness of contrast-enhanced transabdominal ultrasound for tumor classification and tumor staging in the pancreatic head.

OBJECTIVE: To evaluate contrast-enhanced ultrasound (CEUS) and compare it to ultrasound (US) and 64-slice-CT (64-CT) for diagnosing, staging and evaluation of resectability of pancreatic cancer. MATERIAL AND METHODS: US, CEUS and 64-CT were performed in 49 consecutive patients with pancreatic head tumors and with suspected cancer. After evaluation 44 patients had pancreatic head adenocarcinoma and 5 had chronic pancreatitis, all confirmed by histology. RESULTS: The sensitivity of US, CEUS and 64-CT for diagnosing malignant pancreatic head tumors was 89%, 86% and 93%, respectively, and the overall accuracy was 82%, 86% and 88% respectively. There was no significant difference in the malignant tumor size measurement between US and CEUS (p = 0.3619) or between US and 64-CT (p = 0.2129), but a significant difference was seen in the size measured by CEUS and 64-CT (p = 0.0197). The CEUS measurements on the tumor size were smaller. The overall accuracy for M staging of the patients who had surgery for adenocarcinoma was 86% and 90% for US + CEUS and 64-CT, respectively. By performing the CEUS and 64-CT we additionally found, respectively, 35% and 45% non-resectable patients of a group of patients, who were considered resectable on the primary radiological image material. CONCLUSIONS: CEUS may be a useful diagnostic tool in the diagnosis and staging of pancreatic head tumors. For the assessment of resectability CEUS did not prove useful. However, CEUS seemed very useful as an additional instrument in the detection of non-resectable patients already considered resectable on primary radiological image material.

[Diagnostic imaging before liver surgery]. / Billeddiagnostik før leverkirurgi.

In this article the radiological work-up before liver surgery is reviewed. Based upon the latest literature the following is recommended: In patients with liver metastases (LM) or hepatocellular carcinoma (HCC), dedicated magnetic resonance imaging with liver-specific contrast or modern multislice computed tomography (MSCT) of the liver should be performed before liver surgery. Positron emission tomography/computed tomography (PET/CT) is the most accurate modality for detection of extra-hepatic tumours in patients with LM from colorectal cancer. When percutaneous radiofrequency ablation is planned, the patient should be evaluated with contrast-enhanced ultrasound. Biopsy should not be performed before liver surgery when typical imaging findings consistent with LM or HCC are present in patients with colorectal cancer or chronic liver disease. Preoperative assessment of resectability of perihilary cholangiocarcinomas is most precisely done with modern MSCT and percutaneous transhepatic cholangiography.